In the world of cardiologists who treat adults with congenital heart disease, the unusual is not so very unusual and the rare is fairly commonplace. Take Wendy Book, M.D., for example — this week she might meet for the first time a patient presenting with a heart defect from birth for which there is no standard therapy, and for whom there may well be no exact replica on record.

In a giant leap forward in ICD patient safety, the American College of Cardiology Foundation (ACCF), in conjunction with the Heart Rhythm Society (HRS), established the National Cardiovascular Data Registry's national ICD Registry in the fall of 2005 to measure ICD patient outcomes and track patient trends.

When it comes to treating patients suffering from heart failure, which is typically defined as a heart whose pumping power is weaker than normal, physicians are facing a paradox.